Health coalition lists dozens of medical 'Don'ts'

Heather Von St. James holds a CT scan showing her missing left lung. (Reuters/Eric Miller)

Don't use feeding tubes in patients with advanced dementia. Don't use drugs to aggressively treat diabetes in those older than 65. Don't automatically use imaging technology for minor head injuries in children and headaches in adults. And don't give antacids to babies with reflux.

Those are among the 90 medical "don'ts" on a list being released Thursday by a coalition of doctor and consumer groups. They are trying to discourage the use of tests and treatments that have become common practice but may cause harm to patients or unnecessarily drive up the cost of health care.

It is the second set of recommendations from the American Board of Internal Medicine Foundation's "Choosing Wisely" campaign, which launched last year amid nationwide efforts to improve medical care in the United States while making it more affordable.

The recommendations run the gamut, from geriatrics to opthalmology to maternal health. Together, they are meant to convey the message that in medicine, "sometimes less is better," said Daniel Wolfson, executive vice president of the foundation, which funded the effort.

"Sometimes, it's easier [for a physician] to just order the test rather than to explain to the patient why the test is not necessary," Wolfson said. But "this is a new era. People are looking at quality and safety and real outcomes in different ways.

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The guidelines were penned by more than a dozen medical professional organizations, including the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists.

The groups discourage the use of antibiotics in a number of instances in which they are commonly prescribed, such as for sinus infections and pink eye. They caution against using certain sedatives in the elderly and cold medicines in the very young.

In some cases, studies show that the test or treatment is costly but does not improve the quality of care for the patient, according to the groups.

But in many cases, the groups contend, the intervention could cause pain, discomfort or even death. For example, feeding tubes are often used to provide sustenance to dementia patients who cannot feed themselves, even though oral feeding is more effective and humane. And CT scans that are commonly used when children suffer minor head trauma may expose them to cancer-causing radiation.

While the recommendations are aimed in large part at physicians, they are also designed to arm patients with more information in the exam room.

"If you're a healthy person and you're having a straightforward surgery, and you get a list of multiple tests you need to have, we want you to sit down and talk with your doctor about whether you need to do these things," said John Santa, director of the health rating center at Consumer Reports, which is part of the coalition that created the guidelines.

Health-care spending in the United States has reached 17.9 percent of the nation's gross domestic product and continues to rise, despite efforts to contain costs. U.S. health-care spending grew 3.9 percent in 2011, reaching $2.7 trillion, according to the journal Health Affairs.